Provider Demographics
NPI:1336607035
Name:MACDONALD, ROBERT (DAC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:MACDONALD
Suffix:
Gender:M
Credentials:DAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 HILLSIDE ST APT A
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-6496
Mailing Address - Country:US
Mailing Address - Phone:917-915-6481
Mailing Address - Fax:
Practice Address - Street 1:100B DANBURY RD.
Practice Address - Street 2:STE 102
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-0687
Practice Address - Country:US
Practice Address - Phone:917-915-6481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-12
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001975171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist